Cardio Pulm Review Flashcards Preview

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Flashcards in Cardio Pulm Review Deck (63):

What is the primary action of Expectorant agents?

Increase respiratory secretions, which help to loosen mucus. Reducing the viscosity of secretions and increasing sputum volume improves the efficiency of the cough reflex and ciliary action in removing accumulated secretions.


What is the primary action of Mucolytic Agents?

Decrease the viscosity of mucus secretions by altering their composition and consistency, making them easy to expectorate.


When is Oxygen therapy indicated?

In patients with PaO2


What are the indications for tracheostomy?

airway obstruction at or above the level of the larynx and respiratory failure requiring prolonged mechanical ventilation


What are the ratings of the Angina Pain Scale?

1 - mild, barely noticeable
2 - moderate, bothersome
3 - moderately severe, very uncomfortable
4 - most severe or intense pain ever experienced


What are the values for the ABI?

>= 1.3 - indicates rigid arteries and need for an ultrasound test to check for PAD
1-1.3 - Normal; no blockage
.8-.99 - mild blockage, beginnings of PAD
.4-.79 - Moderate blockage, may be associated with intermittent claudication during exercise


How is the ABI calculated?

High of the two blood pressure measurements in ankles/ higher of the two systolic BP measurements in the arms


What is the S1 heart sound characterized by?

(lub) 1st heart sound closure of the mitral and tricuspid valves at the onset of ventricular systole


What is the S2 heart sound characterized by?

(dub) 2nd heart sound - closure of the aortic and pulmonic (semilunar) valves at the onset of ventricular diastole


What is the S3 heart sound characterized by?

vibrations of the distended ventricle walls due to passive flow of blood from the atria during the rapid filling phase of diastole

Normal in health young children, abnormal in adults associated with heart failure - "ventricular gallup"


What is the S4 heart sound characterized by?

Pathologic sound of vibration of the ventricular wall with ventricular filling and atrial contraction

May be associated with ht., stenosis, hypertensive heart disease or MI - "atrial gallup"


Describe the path of blood flow through the heart

O2 poor blood enters right atrium via SVC and IVC->tricuspid valve opens and blood enters the right ventricle-> pulmonary valve opens and blood enters pulmonary artery to go to the lungs -> O2 rich blood returns to heart from lungs via pulmonary veins to the left atrium -> mitral valve opens allowing blood to flow into the left ventricle -> aortic valve opens pushing blood into the aorta and then to the rest of the body


Describe normal tracheal and bronchial sounds

loud tubular sounds, normally heard over the trachea

Inspiratory phase shorter than expiratory phase


Describe normal vesicular breath sounds

high pitched, breezy sounds normal heard over the distal airways

Inspiratory phase longer than expiratory phase


Describe crackles (formerly rales)

Discontinuous, high pitched popping sound more often heard during inspiration

Often heard in the bases of the lungs with interstitial lung disease, atelectasis, pneumonia, bronchiectasis, and PE


Describe pleural friction rub

dry, crackling sound heard during both inspiration and expiration


Describe Ronchi

continuous low-pitched sounds described as having a snoring or gurgling quality that may be heard during inspiration and expiration


Describe stridor

Continuous high pitched wheeze heard with inspiration or expiration

Indicative of upper airway obstruction


Describe wheeze

Continuous musical or whistling sound compose of a variety of pitches

Arise from turbulent airflow and the vibrations of the walls of small airways


Describe bronchial breath sounds

abnormal breath sounds that are heard where vesicular sounds are normally present. (pneumonia may produce these sounds)


Describe Broncophony

Increased vocal resonance with greater clarity and loudness of spoken words (e.g. 99)


Describe Egophony

A form of bronco phony in which the long "E" changes to a long nasal sounding "A"


Describe whispered pectoriloquy

recognition of whispered words "1, 2, 3"


What are normal and abnormal fill times for capillary refill?

2 s - abnormal - capillary blood flow is compromised


What are the classifications for lymphedema?

Mild - 5cm difference between limbs


Describe premature atrial contractions (PAC)

ectopic focus in the atrium initiates an impulse before the SA node

P wave is premature with abnormal config

Common and generally benign


Describe atrial flutter

ectopic, very rapid atrial tachycardia

Saw tooth shaped P waves

occurs with valvular disease, ischemic heart disease, cardiomyopath, acute MI, chronic obstructive lung disease, and pulmonary emboli


Describe Atrial fibrillation

Common arrhythmia where the atria are depolarized b/w 350-600x/min

*No discrete P waves

Occurs in healthy hears, CAD, HTN, and valvular disease


Describe 1st degree AV block

PR interval longer than .2s but relatively constant from beat to beat


Describe 2nd degree AV block

AV conduction disturbance in which impulses b/w atria and ventricles fail intermittently

Mobitz I - progressive prolongation of PR interval until one impulse is not conducted

Mobitz II - consecutive PR inervals are the same and normal followed by nonconduction of one or more impulses


Describe 3rd Degree AV block

*Complete Heart block

All impulses are blacked at the AV node and none are transmitted to the ventricles

Atrial Rate >ventricular rate due to independent pacing


Describe premature ventricular complex

Premature depolarization arising in ventricles do to ectopic focus

P wave usually absent w/ wide aberrant shaped QRS complex

Common arrhythmia that occurs in healthy and diseased hearts


Describe V-tach

3 or more consecutive PVCs at a ventricular rate > 150 bpm

V-tach longer than 30s is a life threatening arrhythmia

Can degenerate into v-fib causing cardiac arrest


Describe v-fib

Ventricles do not beat in a coordinated fashion but fibrillate or quiver asynchronously and ineffectively

No cardiac output - pt becomes unconscious

Requires immediate defib


Describe ventricular asystole

ventricular standstill with no rhythm

Requires immediate CPR and medications to stimulate cardiac activity


What are some signs of Myocardial ischemia and infarction?

ST segment depression

ST segment elevation

Q wave - longer than .04 msec and larger than 1/3 the amplitude of the R wave

T wave inversion - occurs hours or days after MI as a result of a delay in repolarization produced by the injury


What are the absolute indications for terminating a exercise stress test?

Drop in SBP >10 mmHg from baseline despite increase in workload

Moderately severe angina

Increasing nervous system symptoms

Signs of poor perfusion (cyanosis, pallor)

Sustained V-tach

1.0mm ST elevation w/o diagnostic Q-waves


Where do you palpate for the ulnar artery pulse?

at the wrist between the flexor digitorum superficialis and flexor carpi ulnaris tendons


Where do you palpate for the posterior tibial artery?

in the space between the medial malleolus and the achilles tendon, above the calcaneus


What are the characteristics of an obstructive ventilatory impairment?

- Decreased expiratory flows
- Airway narrowing during exhalation causes a disproportionate reduction of maximal air flow compared to the max volume displaced from the lungs


What are the characteristics of restrictive ventilatory impairment?

-Reduced lung volumes and relatively normal expiratory flow rates
- Inferred from spirometry when FVC is reduced and FEV1/FVC is normal or >80%
- Pathologies: interstitial lung disease, tumors, pleural diseases, chest wall deformities, obesity, pregnancy, neuromuscular disease, and tumor


What are the SpO2 values to potentially refer a patient for supplemental O2?


How do you measure Rate Pressure Product (RPP)?


-Correlates with the onset of angina and can be used as a measure to keep exercise prescription below that value to avoid angina and signs of MI


At what RPE value represents 70% of max HR during exercise?



What RPE value corresponds to the upper limit of prescribed training heart rate early in cardiac rehab?



Normal respiratory rate in new borns?

33-45 bpm


Normal Respiratory rate in 1 year olds?

25-35 bpm


What is the Inspiration to expiration rate in COPD?

1:3 or 1:4


What is the Karvonen formula for target heart rate?

Lower THR: {(HRmax - HRrest) x 40%} +HRrest
Upper THR: {(HRmax - HRrest) x 85%} +HRrest


What are the three phases of Active Cycle breathing?

Breathing control, thoracic expansion, forced expiratory technique


What is autogenic drainage?

Theorized to improve airflow in the small airways to facilitate mucus movement through three phases - unsticking phase: slow breathing at low volumes through the nose w/ 2-3s breath holds; Collecting phase - breathing at tidal volume w/ interspersed 2-3s breath-holds; Evacuating phase: deeper inspirations from low to mid inspiratory reserve volume with breath holding and a huff

*requires concentration and motivation to learn but can be done anywhere w/o another person or equipment


What is paced breathing and exhale with effort?

A strategy to decrease the work of breathing and prevent dyspnea during activity for people experience shortness of breath to become less fearful of exercise and activity.. Inhalation with rest phase, exhalation with more active phase.


What is pursed lip breathing?

A simple technique to reduce respiratory rate, reduce dyspnea and maintain a small positive pressure in the bronchioles which may help prevent airway collapse in pts w/ emphysema


Describe Segmental breathing

Technique used to facilitate chest wall expansion through therapist pressure to a segment of the chest wall at the end of exhalation with pt direction to expand the rib cage under the therapists hands


Describe Sustained maximal inhalation w/ incentive spirometer

A maximal inspiratory effort is held for three or more seconds at the point of maximum inspiration before exhalation


What is the semi-fowlers position?

Supine w/ HOB elevated to 45 degrees and pillows under the knees for support - often used for patients with CHF or other cardiac conditions


What are some examples of indications for cardiac rehab?

-Medically stable post MI
-Stable Angina
-Heart transplant


What is phase 1 of cardiac rehab?

Phase 1 (Inpatient): patient/family education, self-care eval, continuous monitoring of vital signs, group discussions, and low level exercise.

Exercises include - AROM, ambulation and self care

3-5 days


What is Phase 2 of cardiac rehab?

(Outpatient Cardiac rehab) Includes prescribed exercise, cardiac risk factor modification, education and counseling about diet and disease management.

After hospitalization can last from 6-12 weeks


What is an example of exercise that takes

Walking slowly at home or office, toileting, driving a car, making a bed, cooking


What are some examples of exercise that takes 3-6 METs?

walking at 3-4 mph 3-7.0 METs
washing windows or a car
Power lawn mowing
carrying or stacking wood
slow dancing, table tennis


What are some examples of things that take >6 METs?

Jogging 5mph, shoveling, carrying heavy loads, heavy farm work, backpacking, basketball, bicycling


What are some indications for a pulmonary rehab program?

presence of respiratory impairnments including dyspnea at rest or with exertion, hypoxemia, hypercapnia, reduced exercise tolerance or decline of ability to perform ADLs due to - chronic brochitis, emphysema, asthma, cystic fibrosis, lung cancer, chest wall disease etc.